COLLISS PARRETT is again advertising the advantages of Naltrexone
as a cure for heroin addiction over other treatments (Letters October 3).

The experts I have spoken to would all like to add Naltrexone to their
armoury of possible treatments, but all acknowledge that none of the
available treatments is suitable for all dependent users.

For instance Naltrexone can be dangerous for users who mix heroin with
some other drugs, as many do.

Naltrexone does not work well for users who are not already motivated
to stop using heroin. Heroin is addictive and drives dependent users to
continue its use with a very effective carrot and stick. Heroin offers
pleasure at the moment of use and extreme pain during the process of
withdrawal.

Rapid Opioid Detoxification uses anaesthesia to blank the pain of
withdrawal and Naltrexone to prevent the pleasurable effects of heroin,
but only for as long as the patient continues to use it. Naltrexone is
not addictive and continuation of the treatment depends entirely on the
will of the patient to continue its use until risk of relapse is gone.
If heroin is used again after Naltrexone treatment has finished,
addiction recurs.

So some can rid themselves of slavery to heroin through abstinence, and
some fail. For some, methadone maintenance works well, whereas for
others it proves a hell on earth. Rapid Opioid Detoxification works for
some, is dangerous for others and yet others relapse after they stop
using the Naltrexone. The Swiss have now shown that some are helped by
heroin maintenance, and there are some specialists who swear by the
efficacy of Ibogaine.

Meanwhile for those who become addicted to heroin and for whom our
present limited range of treatments is not available or is ineffective,
we have nothing to offer. And society as a whole suffers through the
criminal efforts to obtain the money to feed the addiction, through the
high cost of imprisonment and law enforcement, through the ever
increasing death toll, and through the spread of HIV and Hepatitis C,
which frequently punish the innocent.

We need as many methods as can be shown to be effective.

Peter Watney
Holt